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Going to extremes in advancing medicine

Today Larry Altman in the Times writes on Barry Marshall, the Australian who just won the Nobel with Robin Warren for finding the real cause and cure for stomach ulcers, experimenting on himself by swallowing the bacteria he was sure caused the ailment.

This was a brave act, even foolhardy, and in doing so Marshall joined a tradition of rare and dangerous self sacrifice in the cause of knowledge, sometimes ending in the death of the pioneer willing to experiment on himself.

Altman is an expert on the topic, since he wrote the book “”Who Goes First? The Story of Self-Experimentation in Medicine.” We have ordered it; it looks like a fascinating book.

Acts of this sort betray a fervent desire to prove a truth in science and medicine which may be over the top, since some have died from it But it is still admirable, since it serves society in seeking a cure:

In 1929, Dr. Werner Forssmann broke a taboo against touching the beating human heart. As an intern in Germany, he inserted a thin tube into a vein in his elbow and slid it into his heart. Other researchers went on to develop that technique of cardiac catheterization and opened up the modern era of cardiology. Dr. Forssmann shared a Nobel Prize in 1956 for the nine times he had catheterized himself. In one set of experiments, Dr. Forssmann was injected with a radio-opaque chemical as he tried to take X-rays of his heart, a now standard technique known as cardiac angiography


The New York Times

October 9, 2005

When the Doctors Are Their Own Best Guinea Pigs


BACK when the two Australian winners of this year’s Nobel Prize in Medicine suspected that the bacteria they were seeing in biopsies caused stomach inflammation and ulcers, critics insisted that the bacteria were just opportunists, not the culprits.

So one of the two, Dr. Barry J. Marshall, set out to prove the theory by following a traditional method of scientific research: he experimented on himself.

In 1984, Dr. Marshall gulped a potent cocktail of pure Helicobacter pylori bacteria. And promptly became ill. What’s more, his breath stank. Biopsies showed he had developed stomach inflammation that was not there before. Treatment cured the infection and Dr. Marshall stopped the experiment short of getting a full-blown ulcer. But he had made his point.

How many other Dr. Marshalls are out there – scientists who become their own guinea pigs?

No one knows because no one keeps tabs on the number of experiments performed on people in this country or elsewhere. For years, doctors used the initials of subjects, including their own, in reporting their studies, but stopped because of concerns that they were violating confidentiality. So, other than direct acknowledgment from a researcher, there is no way to know how often the tradition of self-experimentation is carried out today. But the anecdotal evidence that it goes on is rife.

Over the years, self-experimenters have made important contributions by developing drugs and vaccines, testing physiological theories and determining the role of vitamins and the causes of some diseases.

Only rarely have they killed themselves in the process.

Researchers cite a number of ethical and practical reasons for experimenting on themselves. Many scientists say they are applying the biblical golden rule to medicine – doing unto themselves before they do unto others. The practical reasons include knowledge of the risks, reliability and convenience.

Self-experimentation can be dated to at least the 16th century, when Santorio Santorio of Padua, Italy, weighed himself daily on a portable steelyard for 30 years. By measuring the weight of his food and drink and his bodily discharges and by recording how his body responded to various physiological and pathological conditions, Santorio made a crucial discovery. He identified a gap between the weight of what he ate and what he discharged, discovering that the body continually loses large but invisible amounts of fluid. Doctors calculate that loss, known as insensible perspiration, in the everyday care of patients.

In 1929, Dr. Werner Forssmann broke a taboo against touching the beating human heart. As an intern in Germany, he inserted a thin tube into a vein in his elbow and slid it into his heart. Other researchers went on to develop that technique of cardiac catheterization and opened up the modern era of cardiology. Dr. Forssmann shared a Nobel Prize in 1956 for the nine times he had catheterized himself. In one set of experiments, Dr. Forssmann was injected with a radio-opaque chemical as he tried to take X-rays of his heart, a now standard technique known as cardiac angiography.

Another German, Gerhard Domagk, won a Nobel Prize in 1939 for discovering the sulfa drugs. In later research, Dr. Domagk sought a substance that would kill cancer cells without harming normal ones. He sterilized extracts of human cancers and, after tests on animals, injected them into himself to learn whether they could be used as a cancer vaccine.

Modern anesthesia evolved from frolics that drew large audiences. In one such show in 1844, a Connecticut dentist, Horace Wells, observed a volunteer breathe nitrous oxide, gash his leg, and not note any pain until the effects wore off. The next day, Dr. Wells asked another dentist to administer the “laughing gas” to him and extract a tooth. When the gas wore off, Dr. Wells exclaimed: “It is the greatest discovery ever made. I didn’t feel as much as the prick of a pin.” He began using it on his patients. Ether, chloroform and other anesthetics followed, in part from additional self-experimenting.

One medical myth is that Walter Reed experimented on himself in Cuba in discovering that mosquitoes transmit yellow fever. But after pledging to be a guinea pig for the mosquito theory, Dr. Reed returned to the United States while two of the three other members of his team experimented on themselves. One died. Another barely survived. After Dr. Reed’s teammates made the crucial breakthrough, he returned to Cuba but never took his turn with a yellow-fever-carrying mosquito.

Lawrence K. Altman, M.D., senior medical writer for The Times, is the author of “Who Goes First? The Story of Self-Experimentation in Medicine.”

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